[Morbidity and mortality after a Hartmann operation due to peritonitis originating from a sigmoid diverticulum disease (Hinchey grade III-IV)].
BACKGROUND
Hartmann's operation has occasionally been criticised for its high morbidity-mortality and permanent stomas. To compare risk factors is difficult due to different severity scores for diverticulitis with no standardisation. We attempted to define the morbidity-mortality of Hartmann's operation for sigmoid diverticulitis with peritonitis Hinchey III-IV and to identify some factors associated with morbidity-mortality and non-restoration of intestinal continuity.


METHODS
Retrospective analysis of 72 patients: age, gender, ASA score, length of time between symptoms and surgery, Hinchey's score, Mannheim index, preoperative creatinine and co-morbidities.


RESULTS
Hinchey's score III, 75%. Male, 35. Median age, 66.5 years. Morbidity-mortality: 48.6% and 23.6%, respectively. ASA > 2 (p = 0.03) and age > 65 years (p = 0.03) in bivariate analysis; and ASA > 2 (p = 0.002) and a history of ischaemic cardiac disease (p = 0.04) in multivariate analysis were associated with postoperative complications. In bivariate analysis mortality was associated with ASA > 2 (p = 0.02), age > 65 years (p = 0.02), chronic obstructive pulmonary disease (p = 0.001), Mannhein index >or= 25 (p = 0.01) and pulmonary postoperative complications (p = 0.003). Multivariate analyses were statistical significant: chronic obstructive pulmonary disease (p = 0.001) and postoperative respiratory infection (p = 0.02). Fifty-five patients survived and 65.5% continued to restoration of intestinal continuity. Age > 65 years (p = 0.004) and ASA score > 2 at first operation (p = 0.004) were predictive for non-reversal of Hartmann's procedure.


CONCLUSIONS
Hartmann's operation is highly associated with morbidity-mortality in severe peritonitis of sigmoid diverticular origin, Hinchey III-IV. The majority of patients have severe co-morbidities and high-grade risk factors which are related to the incidence of morbidity and mortality.
Casal Núñez
José Enrique
JE
Servicio de Cirugía General y Digestiva, Unidad de Coloproctología, Hospital do Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra, España. jose.enrique.casal.nunez@sergas.es
Ruano Poblador
Alejandro
A
García Martínez
María Teresa
MT
Carracedo Iglesias
Roberto
R
Del Campo Pérez
Víctor
V
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003125:Colostomy / Q000009:adverse effects / Q000401:mortality; D003627:Data Interpretation, Statistical; D004239:Diverticulitis, Colonic / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011183:Postoperative Complications; D012189:Retrospective Studies; D012307:Risk Factors; D012810:Sigmoid Diseases / Q000401:mortality / Q000601:surgery*